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Rockwall-Heath High School
Guest Dance Form
Prom – May 2, 2015
Any student requesting to bring a date, who is not a student at Rockwall Heath High School, must have this form
completed and signed. It requires the signature of the principal or administrator at the guest's school and the
RHHS student's parent/guardian signature.
The guest must be under the age of 21 and will be required to present a driver's license or a photo ID at the
dance entrance.
RHHS Student Name ________________________________
Grade Level ____________________
Guest’s Name ______________________________________
Age/Grade Level ________________
Guest’s Parent Name _______________________________
Phone Number__________________
Guest’s School Name ____________________________________________________________________
To be completed by an administrator at guest’s high school:
Name of School ____________________________
School Phone: ___________________
Is the above mentioned student currently in good standing?
Yes
No
Do you recommend that he/she be admitted to a Heath HS function?
Yes
No
______________________________
Signature of Administrator
_____________________________
Title
To be completed if guest is 18 -20 years old
Name of Guest ____________________________
D.O.B ____________
Age: _____________
Signature ________________________________
Cell Phone: ___________________________
As a guest of a Heath student, I understand that all school rules apply during this event:
 I will not be under the influence of drugs or alcohol
 The use of/or possession of tobacco product is not allowed
 Lewd or provocative dancing is not allowed
 Once leaving the dance no reentry is allowed
 I will follow dress code – no jeans or tennis shoes
As a guest at prom, I agree to obey all rules set by RISD and Rockwall-Heath High School. I understand that students
who do not abide by the rules may be asked to leave the dance without warning and will receive consequences according
to current school regulations.
________________________________________
Guest Signature
____________________
Date
I understand that all school rules apply at school functions. I will take the responsibility of reviewing the rules with my
guest.
_______________________________________
RHHS Student Signature
____________________
Date
As a parent of the above mentioned RHHS student, I find his/her date to be a responsible person and I approve him/her
as an acceptable guest for this RHHS school event. I understand that I will be contacted if any school rules are violated by
my child or my child’s guest.
RHHS Parent Signature ____________________
Date ____________
Phone Number ___________________
OFFICE USE ONLY:
RHHS Administrator’s Signature of Approval: _______________________________________ Date:_________________